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Cardiopulmonary resuscitation is a potentially lifesaving intervention, although significant iatrogenic injury may occur. Unlike cardiac and thoracic injuries, the incidence of abdominal injuries as a consequence of cardiopulmonary resuscitation has not been defined. We report a case of significant abdominal injury sustained during cardiopulmonary resuscitation, which was incidentally detected using focussed ultrasound. A review of the available literature summarises the incidence of abdominal injuries sustained during cardiopulmonary resuscitation. We consider whether the standard application of focussed abdominal ultrasound is desirable as part of post-resuscitation care. Clinicians should consider the potential for iatrogenic injuries following resuscitation, especially where persistent and unexplained haemodynamic instability occurs following return of spontaneous circulation. Many emergency departments have access to point-of-care ultrasound and staff skilled in focussed assessment with sonography for trauma. Post-resuscitation detection of abdominal injuries could be facilitated by utilising this approach. This may improve outcomes for patients with potentially treatable injuries that may have otherwise been missed or diagnosed late.

An immediate, effective team response is needed in order to properly cater to the needs of trauma patients. This paper aims to review some of the strategies that can be implemented in Emergency Departments to reduce errors and improve decision-making in major trauma. It focuses on the phase prior to the patient’s arrival, and in the first few minutes afterwards – as there is evidence that an organised response at this point creates the ideal conditions for all subsequent activity, such as transfer of the patient for further imaging and the requirement for emergency surgery.

Traumatic cardiac arrest is known to have a poor outcome, and some authors have stated that attempted resuscitation from traumatic cardiac arrest is futile. However, advances in damage control resuscitation and understanding of the differences in pathophysiology of traumatic cardiac arrest compared to medical cardiac arrest have led to unexpected survivors. Recently published data have suggested that outcome from traumatic cardiac arrest is no worse than that for medical causes of cardiac arrest, and in some groups may be better. This review highlights key areas of difference between traumatic cardiac arrest and medical cardiac arrest, and outlines a strategy for the management of patients in traumatic cardiac arrest. Standard Advanced Life Support algorithms should not be used for patients in traumatic cardiac arrest.

Impedance threshold devices are a novel therapeutic option to increase blood pressure in the spontaneously breathing, hypotensive, trauma patient. They have multiple potential mechanisms of action. The most important is their ability to induce a more negative intrathoracic pressure during inspiration. They achieve this by the presence of a series of valves. These valves only open once the patient has generated a more negative intrathoracic pressure than is normally required for inspiration to occur. This negative intrathoracic pressure is thought to increase venous return and therefore cardiac output and subsequently blood pressure. This narrative review examines the evidence pertaining to the use of these devices in spontaneously breathing, hypotensive, trauma patients. While the literature supports the ability of these devices to increase systolic blood pressure in both animal and human models of hypotension, and more recently in patients with true pathological hypotension, potential flaws are discussed, and several key questions that have not been addressed by studies to date are highlighted. Notwithstanding these problems, impedance threshold devices may have a role in hypotensive trauma patients, particularly during the pre-hospital phase of care when available resources limit treatment options. Further work is required to prove both their clinical effectiveness and safety.

This review describes the evidence exploring the use of a two-tier trauma team activation system, reviewing the background, history, data available and potential benefits and downsides. The current evidence suggests that a two-tier system may be a lean, cost-effective system, focussed on patient outcome, which could be implemented throughout the UK. Despite its current use in some hospitals, there is limited data from similar systems supporting this in a UK setting. Specific activation criteria need to be validated to ensure appropriate activation of trauma teams, ensuring optimal patient outcome and ensuring best practice.

Sternoclavicular joint (SCJ) injuries are uncommon, but delay in diagnosis and treatment can result in significant morbidity. This review outlines the relevant clinical anatomy and biomechanics of the joint, and examines the evidence supporting specific investigation and management of such injuries.

Seatbelts save lives. However, they may cause injury to adjacent structures and when they malfunction can cause injury to the abdominal viscera, bony skeleton and vascular structures. The motor industry has attempted to reduce these injuries by modification of vehicle design and safety equipment. This paper discusses the patterns of injury caused by seatbelts and the methods by which the motor industry attempts to reduce their incidence.

Crush syndrome remains rare in European practice. It is however common in areas of civil disorder and where the normal structures of society have given way to civil war or natural disaster. Western doctors are becoming increasingly involved in such situations and there is no reason to believe that instances due to more conventional causes, such as collapse in the elderly or road traffic accidents, will cease. For all these reasons it is important that clinicians who deal infrequently with crush syndrome have access to appropriate guidelines. This consensus report seeks to provide such advice. It reports the findings of a consensus meeting on crush injury and crush syndrome held in Birmingham on 31 May 2001, and coordinated by the Faculty of Pre-Hospital Care of the Royal College of Surgeons of Edinburgh.

In order to achieve optimal care for patients, it is essential that care is based on the best available evidence. Best Evidence Topics are short digests of the available research, summarised in a systematic format, accessible for the busy professional. Trauma will now add to the collection of journals that feature BestBETs. All clinicians involved in the care of the injured can contribute to this process by defining and disseminating the knowledge basis for our clinical practice. The invitation for you to derive, submit and publish is now open.

Objective To understand decision-making when bringing a child to an emergency department. Design A cross-sectional survey of parents attending with children allocated a minor triage category. Setting Emergency department in South West England, serving 450,000 people per annum. Participants All English-speaking parents/caregivers whose children attended the emergency department and were triaged as minor injury/illness. Main outcome measures Parental and child characteristics, injury/illness characteristics, advice seeking behaviour, views regarding emergency department service improvement, GP access and determinants of emergency department use. Results In sum, 373 responses were analysed. The majority of attendances were for minor injury, although illness was more common in Conclusions The findings suggest that it is difficult for parents to determine whether their child’s symptoms reflect minor conditions. Efforts should focus on building parental confidence and self-help and be directed at parents of younger children and younger parents. This is in addition to appropriate minor injury/illness assessment and treatment services.